What I learnt last week: Not everything should be open: the value of “Closed Loop Communication” #WILTW

Due to an number of issues this posting never quite made it last week – this is the 34th #WILTW

A recurring theme in my #WILTW series is learning from, or failing to learn from, previous experiences.

Just before Christmas our department ran a simulation day with one of the learning points:

Following this event I was involved in a case where a number of physiological observations (Heart Rate, Breathing rate etc) needed to be performed on a child. The child had been brought in by ambulance and, although features of their presenting complaint indicated they may be at risk of hypovolaemia (a significant reduction in the circulating volume of blood), on arrival in the department visual inspection revealed an alert, happy child interested in their surroundings.

I wasn’t directly involved in the initial assessment of the child but had asked for confirmation their ‘obs’ were normal. The answer was in affirmative and after a period of observation and investigation the child was admitted to the children’s hospital assessment unit.

I have had pause to reflect on this case as it transpired, at the time of asking, all the observations had been normal but not all observations that could have been performed were. My question had been open-ended, and so, therefore, was the response i.e. I had assumed I was thinking about the same observations as the person I was directing the question to. In this situation no harm was done but when managing critically ill patients in resuscitation scenarios, “closed loop communication” becomes very important.

Closed Loop Communication

Taken from Resuscitation Team Concept

There are many quotes about making assumptions and not all are suitable for an open posting. I leave you with the following:

Assumption isWhat did you learn this week? #WILTW

Other useful articles on communication include Human Factors and Quality in Resuscitation and Resuscitation Team Organization for Emergency Departments: A Conceptual Review and Discussion

3 thoughts on “What I learnt last week: Not everything should be open: the value of “Closed Loop Communication” #WILTW”

  1. also shows why guidelines are so important and also reinforces that even children who have lost large volumes of blood may not ‘look’ unwell…. we can all think of the child with serious pathology who waved and smiled before crumpling in a heap. Childrens reserve is a blessing and also a curse for paediatricians weeding out the well from the unwell. Hence the value of observation and stealth like inactivity 🙂

  2. Totally agree with this and it is one of the most common points of feedback in our in situ sim sessions.

    ‘Can Somebody’ and ‘Can We’ are seemingly the most capable, universal and awesome members of any resus team….., or at least they would be if they existed.

    Great thoughts as always.

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